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Drugs!! > Cardio-vascular drugs > Flashcards

Cardio-vascular drugs Flashcards

1
Q

Why is aspirin contra-indicated in children? (1)

A

Aspirin in children is associated with Reye’s syndrome.

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2
Q

What is Reye’s syndrome? (2)
What is the main age of children affected? (1)
What are the 2 main causes acknowledged? (2)

A

Severe, progressive encephalopathy affecting children (peak at age 2) that is accompanied by fatty infiltration of the liver, kidneys and pancreas.
Aspirin use and viral cause.

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3
Q

Name 3 side effects of thiazide diuretics. (3)

A

Increased serum cholesterol
Hypokalaemia
Hyperuricaemia (may precipitate gout)
Impairment of glucose tolerance

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4
Q

Name 3 common side effects of beta blockers. (3)

A

Bradycardia, bronchospasm, cold extremities, fatigue and weakness.
Exacerbation of intermittent claudication, nightmares and hallucinations

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5
Q

Name 3 beta blockers that are more cardio-selective. (3)

A

Atenolol, Bisoprolol, Nebivolol, Acebutolol, Metoprolol

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6
Q

name 3 side effects associated with treatment with ACE inhibitors. (3)

A

First-dose hypertension, dry cough, proteinuria, rash, leucopenia.

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7
Q

Why are ACE inhibitors contraindicated in renal artery stenosis? (2)

A

AT2 is powerful vasoconstrictor,
In renal artery stenosis, constriction of the efferent arteriole is vital to maintain GFR and blood flow to the kidney.
Loss of AT2 leads to vasodilation
Vasodilation means less blood flow to the kidney

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8
Q

Why do ARBs not cause dry cough caused by ACEi? (1)

A

Bradykinin is broken down by ACE, ACE inhibitors can therefore prevent this and levels can build up causing a cough.

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9
Q

Name 2 dihydropyridine calcium channel blockers. (2)

A

Felodipine, amlodipine, nifedipine

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10
Q

Which 2 calcium channel blockers are contraindicated in heart failure? (2)
Which is the most negatively ionotropic? (1)

A

Diltiazem and verapamil

Verapamil is highly negative ionotropic and decreases cardiac output and heart rate, diltiazem is less so.

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11
Q

Which calcium channel blocker is particularly contraindicated with beta blockers? (1)

A

Verapamil.

Diltiazem is used in caution.

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12
Q

What is labetalol’s second classification? (1)

A

Beta blocker and also has some vasodilator properties.

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13
Q

Which calcium channel blocker can be used to treat raynauds syndrome? (1)

A

Nifedipine

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14
Q

Which calcium channel blocker is licensed for use in SVT’s? (1)

A

Verapamil

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15
Q

Name 2 side effects of calcium channel blockers. (2)

A

Bradycardia, headaches, flushing, fluid retention (oedema) and cardiac conduction defects (V&D only)

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16
Q

What is the mechanism of action of adenosine? (2)

Name the main indication. (1)

A

Enhances flow of potassium out of myocardial cells causing hyperpolarisation and stabilisation of cell membranes. It has potent effects on the SA node and slows conduction through the AV node.
Atrioventricular junction tachycardias eg Wolff-Parkinson-White

17
Q

Name 3 important things regarding the administration of adenosine. (3)

A

Rapid IV injection
Into central or large peripheral vein
Cardiac monitoring and resuscitation available
CI: asthma, heart block (unless pacemaker fitted)

18
Q

What is the Vaughan Williams classification? (4)

A

Classification of anti-arrhythmics.
Class I: Sodium channel blockers (lidocaine, flecainide)
Class II: Beta blockers
Class III: Potassium channel blockers (amiodarone)
Class IV: Calcium channel blockers (D&V)

19
Q

What is the mechanism of action of amiodarone? (2)

A

Potassium channel antagonist.. slows repolarisation and so prolongs refractory period.

20
Q

What are the indications of amiodarone? (2)

A

In CPR, when pulseless VT and VF are unresponsive to other interventions.
Treatment of arrhythmias (SVT and VT, AF) especially when other therapies are not tolerated or ineffective.

21
Q

How is oral amiodarone initiated? (2)

A

Week 1: 200mg TDS
Week 2: 200mg BD
Week 3 onwards : 200mg OD

22
Q

What monitoring is required for amiodarone? (2)

A

TFTs before and 6 monthly

LFTs before and 6 monthly

23
Q

Name 4 side effects of amiodarone therapy. (4)

A 
Hypothyroidism
hyperthyroidism 
Liver toxicity
Corneal microdeposits (reversible)
Phototoxic skin reactions (total sunblock cream)
Slate-grey skin pigmentation
Pneumonitis
Peripheral neuropathy
24
Q

Bill was on amiodarone for control of his arrhythmia, however, it was stopped 1 month ago and he is now starting warfarin therapy.
What is the worry? (1)

A

Amiodarone has a very long half life and can remain in the body for several weeks. It interacts with warfarin.

25
Q

What is the mechanism of action of digoxin? (2)

A

Blocks AV conduction
Reduces heart rate by enhancing vagal nerve activity and inhibiting sympathetic nerve activity
Positively ionotropic by increasing intracellular calcium levels.

26
Q

What monitoring should be undertaken before starting digoxin therapy? (1)

A

U&E’s for renal function. If reduced renal function, dose should be reduced.

27
Q

Name 4 side effects of digoxin? (4)

What electrolyte imbalance can predispose to toxicity? (1)

A

Nausea, vomiting, diarrhoea, blurred or yellow/green vision. Toxicity: Ventricular arrhythmias or bradyarrhythmias.
Hypokalaemia (and renal failure)

28
Q

How are beta blockers beneficial in heart failure? (2)

A

Decrease heart rate, reduce force on contraction and decrease blood pressure => reduce myocardial oxygen demand and more time for coronary perfusion.

29
Q

What is the mechanism of action of nitrates? (2)

A

Increase cGMP in vascular smooth muscle cells
=> decrease in intracellular calcium levels
=> smooth muscle relaxation of veins and arteries
=> reduce venous return and workload of LV

30
Q

Why are nitrates used sub lingually preferentially? (1)

A

S/L route avoids first pass metabolism

Also in case of tablets can be removed once effect has been achieved to avoid unwanted effects.

31
Q

What valvular problem is a contraindication for calcium channel blockers? (1)

A

Aortic stenosis

32
Q

What drug classification is nicorandil? (1)

A

Potassium channel activator (it indirectly causes calcium channel blockade and arterial dilation.

33
Q

What is the mechanism of aspirin? (2)

A

Irreversible inhibition of cyclo-oxyegnase, reducing platelet production of thromboxane A2.

34
Q

What is the mechanism of dipyridamole? (2)

A

Inhibits phosphodiesterase-mediated breakdown of cAMP (more cAMP) so prevents platelet activation.

35
Q

What is the mechanism of action of clopidogrel? (2)

A

Blocks platelet aggregation and prolongs platelet survival by inhibiting the binding of ADP to it’s platelet receptor.

Drugs!! (10 decks)

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